Binswanger病、脑白质疏松症及其合并脑梗死患者的认知功能障碍

目的　探讨Binswanger病 (BD)、脑白质疏松症 (LA)及LA合并脑梗死 (LA +CI)患者的认知功能障碍程度及其临床意义。方法　采用简易精神状态量表 (MMSE)和临床记忆量表 (CMS)检查BD(33例 )、LA(2 7例 )、LA +CI(31例 )患者及健康对照者 (30名 )的认知功能状态 ,并比较其障碍的程度。结果　 (1)BD组、LA组、LA +CI组MMSE及CMS评分均明显低于对照组 (P <0 0 5～ 0 0 1)。 (2 )BD组、LA +CI组MMSE及CMS评分均明显低于LA组 (P <0 0 5～ 0 0 1)。 (3)LA组轻度认知功能障碍 2 1例 (77 8% ) ;BD组中度认知功能障碍 8例 (2 4 2 % ) ,痴呆 2 5例 (75 .8% ) ;LA +CI组中度认知功能障碍 6例 (19 4 % ) ,痴呆 2 4例 (77 4 % )。结论LA大多有轻度认知功能障碍 ,而BD和LA +CI多为中度认知功能障碍和痴呆。认知功能障碍的程度是临床诊断BD、LA的参考指标。     

脑白质疏松症患者的诱发电位研究

对２４例经颅脑ＣＴ证实的脑白质疏松症患者进行脑干听觉诱发电位（ＢＡＥＰ）和短潜伏期体感觉诱发电位（ＳＥＰ）检查，结果ＢＥＡＰ总异常率７９％，ＳＥＰ总异常率８３％，两种诱发电位均以时间参数的异常率明显比波幅度参数的异常率高。结论：在脑白质疏松症的临床早期，虽然还未出现典型的临床表现，但脑电生理已出现异常，诱发电位的检测可以作为早期诊断该病的一个敏感的辅助检测方法。     

脑白质疏松的病理与影像学关系的研究

目的：研究脑白质疏松确切的病理变化及其与影像学（CT／MRI）的关系。方法：将10年来我科收治的63例影像学表现为脑白质疏松的患者的临床及影像学资料进行总结,其中10例死后进行了病理检查。结果：脑室周围深部白质,半卵圆中心,放射冠部位的病理学表现为：（1）髓鞘结构紊乱,体积变小,数量减少;（2）轴索变性,萎缩和脱失,（3）白质内明显的小血管硬化和胶质细胞增生;（4）多发性腔隙性梗死灶。结论：病理证实的脱髓鞘改变,CT显示的脑室周围低密度性改变,MRI的T2加权像显示的双侧弥漫性高信号三者部位一致。     

脑白质疏松的临床研究进展

脑白质疏松（ＬＡ）是神经影像学描述性术语,包括了各种原因、不同发病机制的白质病变,亦可见于正常老年人。ＬＡ本身与特定的异常神经行为如痴呆和下肢功能障碍相关。本文阐述了产生这一现象的病理生理学和病理解剖学机制以及临床重要意义。     

The association between white matter changes and development of malignant middle cerebral artery infarction: A case–control study

Disrupted blood–brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.In this case–control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444–28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107–28.399, P = .0372) were significantly associated with MMI development.MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.     

脑白质疏松症患者睡眠障碍及其影响因素分析

目的：探讨脑白质疏松症（LA）患者睡眠障碍的影响因素。方法选择90例符合 MRI 诊断标准的 LA 患者（LA组）和90例性别、年龄相匹配的正常老年人（NC 组）作为研究对象;通过询问病史调查血管危险因素,采用匹兹堡睡眠质量指数（PSQI）量表评定睡眠障碍情况,依据头颅 MRI 表现将 LA 组分为4个等级。结果 LA 组高血压和糖尿病发生率显著高于 NC 组（P <0.05）,LA 组 PSQI 评分显著高于NC 组（P <0.01）。LA 组随着 LA 分级升高,PSQI 评分依次增高（P <0.05）。回归分析显示,年龄、高血压、糖尿病、蒙特利尔认知评估量表等与 LA 患者睡眠障碍有关。结论LA 患者存在睡眠障碍,与 LA 病变程度、认知损害、年龄、高血压、糖尿病等密切相关。     

脑白质疏松与抑郁发生率的相关性研究

目的分析不同程度脑白质疏松(LA)与抑郁发生的相关性。方法选择经头颅MRI检查确诊的LA患者132例为LA组;同期收集132例有头痛、头晕的健康体检者为非LA组。所有患者均进行汉密尔顿抑郁量表评分,比较2组抑郁的发生率,并分析LA的严重程度与抑郁的相关性。结果与非LA组比较,LA组抑郁发生率明显升高(21.2%vs 62.9%,P<0.01)。与非LA组比较,LA组轻度抑郁、中度抑郁和重度抑郁汉密尔顿抑郁量表评分明显升高,差异有统计学意义[(9±2)分vs(12±2)分和(15±2)分和(21±2)分,P<0.01]。logistic回归分析显示,年龄(OR=9.550,95%CI:1.174².050,P=0.002)、高血压(OR=10.330,95%CI:1.4982.050,P=0.002)、高血压(OR=10.330,95%CI:1.498⁵.300,P=0.001)、腔隙性脑梗死(OR=16.514,95%CI:1.8245.300,P=0.001)、腔隙性脑梗死(OR=16.514,95%CI:1.824⁵.590,P=0.000)、LA(OR=4.933,95%CI:1.0815.590,P=0.000)、LA(OR=4.933,95%CI:1.081³.498,P=0.026)为抑郁的危险因素。结论 LA的不同严重程度与抑郁有关。     

A homozygous genetic variant of mitochondrial uncoupling protein 4 affects the occurrence of leukoaraiosis

Szolnoki Z, Kondacs A, Mandi Y, Bodor A, Somogyvari F. A homozygous genetic variant of mitochondrial uncoupling protein 4 affects the occurrence of leukoaraiosis.
Acta Neurol Scand: 2011: 123: 352–357.
© 2010 John Wiley & Sons A/S. Objectives – We hypothesized that an appropriate balance of the mitochondrial energy production is essential in the maintenance of the glia cells in the brain. The aim of this study was to examine the roles of the rs10807344 and rs2270450 genetic variants of mitochondrial uncoupling protein 4 in the development of vascular demyelinization of the white matter of the brain, referred to as leukoaraiosis (LA). The mUCPs are presumed to be of great importance in the regulation of the mitochondrial membrane potential (MMP) and the cellular energy metabolism. Materials and methods – An analysis was performed on the clinical and genetic data on 401 LA patients without infarction and on 451 neuroimaging alteration‐free subjects. After univariate statistical approaches, logistic regression models were also used to adjust differences in significant clinical factors between the patients and controls. Results – The rs10807344 CC genotype proved to exert a protective effect on the occurrence of LA (neuroimaging alteration‐free controls: 57.7%, LA group: 44.9%, P < 0.0002; adjusted OR: 0.41, 95% CI: 0.2–0.68, P < 0.005). Conclusion – The present findings indirectly raise the possibility that a shift or imbalance in the finely regulated MMP may play a role in the development of LA.     

Whole brain apparent diffusion coefficient histogram: a new tool for evaluation of leukoaraiosis

PURPOSE: To test whole brain apparent diffusion coefficient histogram analysis as an alternative approach to visual score for the assessment of leukoaraiosis (LA). MATERIALS and METHODS: T2 and diffusion weighted images were obtained in 15 elderly patients. LA extension was assessed on T2 weighted images by two observers using a semiquantitative visual score. Apparent diffusion coefficient (ADC) maps of the entire brain were generated and, after exclusion of the skull with manual tracing and of the cerebrospinal fluid (CSF) by application of a threshold value, whole brain (WB)-ADC histogram was obtained. Moreover, a brain volume index (BVI) was calculated on ADC maps as (intracranial volume - CSF volume) /intracranial volume. RESULTS: The kappa inter-observer agreement for LA scoring was 0.69. Manual segmentation of the skull showed a mean inter-operator coefficient of variation below 3%. The median value of whole brain ADC histogram directly correlated with LA extension (P = 0.013). Moreover a significant inverse correlation (P = 0.002) was found between WB-ADC median value and BVI. CONCLUSION: WB-ADC histogram is a reproducible alternative tool for assessing LA extension and severity.